Sub-Saharan African countries that invest in training doctors lose billions of dollars when those clinicians leave to work in developed nations, finds research recently published by BMJ ( bmj.com). a journal of the British Medical Association. The study was conducted with the help of seven universities, including UW. The United States alone has saved $846 million from not having to train doctors who emigrated from the nine African countries in the study.

Wealthy countries such as the United States are benefiting significantly from the African loss of physicians, as thousands of trained doctors emigrate from African countries suffering a shortage of health workers. According to the study, South Africa and Zimbabwe suffer the greatest economic losses when their doctors emigrate, while Australia, Canada, the United Kingdom and the United States benefit the most from the recruitment of physicians educated in other countries.

The team of authors is led by Edward Mills, chair of global health at the University of Ottawa. The researchers call for the destination countries that benefit from doctor migration to invest in training and health systems in the source countries.

“The migration of health workers from poor countries contributes to weak health systems in low-income countries and is considered a primary threat to achieving the health-related millennium development goals,” said researcher Amy Hagopian, UW assistant professor of global health. She said one in four U.S. physicians was trained abroad, two-thirds of those from a lower-income country.

In 2010, the World Health Assembly adopted the first “Code of Practice on the International Recruitment of Health Personnel” that recognizes problems associated with doctor migration. The Code of Practice calls on wealthy countries to provide financial assistance to source countries affected by health worker losses. The Code of Practice is particularly important for sub-Saharan Africa which has a critical shortage of doctors and a high prevalence of diseases such as HIV/AIDS.

Mills and colleagues estimated the monetary cost of educating a doctor through primary, secondary and medical school in nine sub-Saharan countries with significant HIV-prevalence. These included Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia and Zimbabwe.

The results show governments spend between US $21,000 (Uganda) to $59,000 (South Africa) to train each doctor. The countries in the study collectively paid around US $2 billion to train their doctors, only to see them migrate to richer countries, say the authors. They add that the benefit to the United Kingdom was around US $2.7 billion and for the United States around US $846 million.

The research team added the figures from publicly available data, including published reports on primary and secondary school spending from UNESCO, to estimate how much the origin countries paid to train doctors and how much the destination countries saved in employing them.

In an accompanying editorial, James Buchan from Queen Margaret University in Edinburgh, says the study raises important issues about freedom of movement. He questions whether doctors and other health workers should have cost constraints placed on their mobility when other professionals such as engineers escape such restrictions.

Buchan says that while the WHO Code may help name and shame aggressive recruiters, the post-recession labor market and changing health systems will also have an impact on doctors leaving developing countries. He says several destination countries are adjusting their projected need for new staff and “the UK, for one, has drastically reduced its level of active international recruitment for most types of health professionals.”

Press inquiries should be sent to researchers Edward Mills at edward.mills@uottawa.ca or Amy Hagopian at hagopian@uw.edu.